Medical Billing and Coding

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to ensure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs in areas of specialization.
• Sequence the diagnoses and procedures using coding guidelines.
• Ensure DRG/APC assignment is accurate.
• Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
• Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information.
• Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
• Assist with special projects as required.
• Perform other related duties incidental to the work described herein.

Medical Records Coder II – Ophthalmology

• Accurately assigning diagnosis and procedure codes to inpatient discharges
• Keeping abreast of new coding developments
• Possess knowledge and experience for accurate code assignment
• Coding Obstetrics, Newborn and Behavioral Health encounters when assigned
• Querying physicians for unclear documentation
• Working with Clinical Documentation Specialists for optimal DRG assignment
• Maintaining department productivity standards with 95% accuracy
• Other duties as assigned

Inpatient Coder/Abstractor – Health Information Management

• The Senior Inpatient Coder is responsible for accurately assigning diagnosis and procedure codes to inpatient discharges at the larger McLeod Health facilities representing more complex medical/surgical encounters.
• Keeps abreast of all new coding developments by attending any coding classes, reading articles on coding updates, and attending seminars when available.
• Possess inpatient coding knowledge and experience necessary to accurately assign codes to determine correct principal diagnosis, identify and assign co-morbidities and complications, secondary diagnoses, present on admission indicator, discharge disposition, Hospital Acquired conditions, principal procedure, and secondary procedures on all discharged inpatient records to arrive at the most appropriate DRG assignment.
• Understands coding guidelines to accurately apply coding principles to encounters with longer lengths of stay, complex medical diagnoses and extensive surgical procedures. This includes cardiac, neurosurgery, orthopedic, pediatric, trauma, and vascular.
• Queries physicians appropriately when documentation is not clear in the medical record.
• Works closely with the Clinical Documentation Specialists to assure the most optimal DRG is assigned.
• Maintains department specific productivity standards with a 95% accuracy rate.
• Performs other duties as assigned.

Inpatient Coder/Abstractor Sr – Health Information Management

• Coordinate annual and quarterly ICD-10, CPT, and HCPCS code updates.
• Review and analyze coding changes to determine business and operational impacts.
• Prepare code change documentation for stakeholder review.
• Collaborate with business users, stakeholders, and technical teams to implement coding and policy updates.
• Participate in meetings related to healthcare systems modernization initiatives.
• Serve as a Subject Matter Expert (SME) for medical coding methodologies and Medicaid-related processes.
• Research business rules, requirements, and workflows to develop recommendations.
• Maintain business rules, process documentation, and requirements repositories.
• Support process documentation, knowledge transfer, and training activities.
• Review medical records against established criteria to determine medical necessity when required.
• Assist with additional healthcare and project-related initiatives.

Clinical Analyst, Coding Specialist

• Evaluates medical records, provides clinical and surgical abstraction and assigns appropriate clinical diagnosis and procedure codes.
• Analyzes medical information from medical records
• Accurately codes diagnostic and procedural information in accordance with national coding guidelines
• Consults with medical providers to clarify missing or inadequate record information and to determine appropriate codes.
• Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards.

Profee Coder – Primary Care

• Ensure 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, ICD-10-CM codes and modifiers.
• Daily review of EPIC Charge Review Work queues is essential.
• Monitor and report on accounts receivable issues related to payer compliance and/or billing processes.
• Act as a resource to providers, office staff, administration and the Central Business Office.
• Participation in coding training and education is also required.
• Maintain yearly certification as a Certified Professional Coder is required with the American Academy of Professional Coders.

Senior Billing Liaison, Coder

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with unclear, or unsubstantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

Outpatient Surgery Coder

• Reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software
• Responsible for coding high dollar and long length of stay cases for all patient types
• Serves as a subject matter expert to Coding department leaders and peers
• Recommends modifications to current policies and procedures as needed to coincide with government regulations
• Collaborates with the Clinical Documentation Improvement and Quality teams to ensure a match in the DRG and reconciles each Medicare case from a CDI perspective
• Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding
• Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested

Inpatient Coder Specialist – Community Facility

• Accurately assigns diagnosis and procedure codes for inpatient facility and professional services.
• Performs necessary tasks within MHS GENESIS and other military coding systems.
• Accurately assign Evaluation and Management (E&M) codes, ICD-CM diagnoses, CPT and HCPCS, modifiers, and quantities derived from medical record documentation.
• Reviews encounter and/or record documentation to identify and resolve inconsistencies, ambiguities, or discrepancies.
• Assigns accurate codes based on provider responses to coding queries.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance.
• Utilizes MHS computer systems to remotely access patient records and assign codes for patient encounters in support of other MTFs.
• Achieve and maintain DHA coding productivity and accuracy standards for the position.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding.
• Responds to provider questions and provides examples of appropriate coding and documentation reference(s).

Medical Coder II

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs on areas of specialization.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs.

Medical Records Coder II – Outpatient

• Accurately enter patient charges, diagnoses (ICD-10), procedures (CPT/HCPCS), modifiers, and units into billing systems.
• Review charge documents for completeness, accuracy, and compliance prior to entry.
• Identify and correct errors, discrepancies, and duplicate charges before claim submission.
• Ensure charges align with provider documentation and payer requirements.
• Maintain productivity and quality standards while meeting daily deadlines, especially during end-of-month (EOM).
• Communicate effectively with internal teams (coding, billing, AR, leadership) to resolve charge-related issues.
• Follow HIPAA guidelines and protect patient confidentiality at all times.
• Adhere to departmental workflows, policies, and compliance standards.
• Participate in audits, quality reviews, and ongoing training as assigned.

Claims Specialist

• Process and submit medical claims accurately and on time
• Assign appropriate ICD-10, CPT, and HCPCS codes
• Review documentation for coding compliance
• Follow up on denied or unpaid claims as needed
• Communicate with providers, payers, or clients when necessary
• Maintain HIPAA compliance and data security standards

Medical Biller, Coder

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – Cardiology

• Identify opportunities to improve provider documentation and create an education plan tailored to each assigned provider
• Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements
• Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques
• Provider onsite education, based on business needs
• Collaboration with other market provider facing role
• Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards
• Analyze coding audit results and other relevant data to develop data-driven educational materials and interventions
• Participate in cross-functional teams to improve documentation, data integrity, and workflow processes

Medical Coder

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings, ensuring expert application of modifiers and E/M guidelines
• Perform entry-level facility coding for simple outpatient encounters (e.g., diagnostic imaging, labs) and basic inpatient services (e.g., uncomplicated admissions, short stays) using ICD-10-CM and ICD-10-PCS, where applicable
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – ENT, Audiology

• Responsible for abstracting and validating CPT, ICD-10 and HCPCS codes for inpatient, outpatient and physician's office/clinic settings.
• Adheres to all coding and compliance guidelines.
• Maintains knowledge of coding/billing updates and payer specific coding guidelines.
• Serves as a subject matter expert for assigned specialty.
• Abstracts/codes for assigned provider(s)/division(s) based on medical record documentation.
• Utilizes appropriate coding software and coding resources in order to determine correct codes.
• Communicates billing related issues to assigned supervisor/manager and participates in meetings in order to improve overall billing, when applicable.
• Follows departmental policies for charge corrections.
• Participates in coding educational opportunities (webinars, in house training, etc.).
• Provides feedback to providers in order to clarify and resolve coding concerns.
• Resolves assigned pre-billing edits.
• Assists in identifying areas that require additional training.
• Mentors and assists in training other coders and new team members.

Ambulatory Coder III, ENT

• Responsible for validating/reviewing and assigning applicable CPT, ICD-10, Modifiers and HCPCS codes for inpatient, outpatient and physicians office/clinic settings.
• Adheres to all coding and compliance guidelines.
• Maintains knowledge of coding/billing updates and payer specific coding guidelines for multi-specialty medical practice(s).
• Communicates with providers and team members regarding coding issues.

Ambulatory Coder II, Professional Billing

• Responsible for abstracting and validating CPT, ICD-10 and HCPCS codes
• Adheres to all coding and compliance guidelines
• Maintains knowledge of coding/billing updates and payer specific coding guidelines
• Communicates billing related issues to assigned supervisor/manager
• Participates in coding educational opportunities
• Provides feedback to providers to clarify and resolve coding concerns
• Resolves assigned pre-billing edits
• Assists in identifying areas that require additional training
• Mentors and assists in training other coders and new team members

Ambulatory Coder II, Ortho

• Responsible for abstracting and validating CPT, ICD-10 and HCPCS codes for inpatient, outpatient and physician's office/clinic settings
• Adheres to all coding and compliance guidelines
• Maintains knowledge of coding/billing updates and payer specific coding guidelines
• Serves as a subject matter expert for assigned specialty
• Communicates billing related issues to assigned supervisor/manager
• Participates in coding educational opportunities (webinars, in house training, etc.)
• Provides feedback to providers in order to clarify and resolve coding concerns
• Resolves assigned pre-billing edits
• Assists in identifying areas that require additional training
• Mentors and assists in training other coders and new team members

Ambulatory Coder III

• Codes medical information into the Prisma billing/abstracting systems using established professional and regulatory coding guidelines.
• Ensures that each diagnosis present on admission (POA) indicator is assigned appropriately.
• Codes for multiple facilities.
• Adheres to Prisma Health Coding and Compliance policies and procedures for assignment of complete, accurate, timely and consistent codes.
• Performs Inpatient coding including major traumas and Neonatal Intensive Care Unit (NICU) records by assigning International Classification of Diseases (ICD) and International Classification of Diseases-Procedure Coding System (ICD-PCS) codes as well as the Diagnosis Related Groups (DRG) assignment.
• Abstracts and assigns and verifies codes for Major Complications and Comorbidities/Complications and Comorbidities (MCC/CCs), Hospital-Acquired Condition/Patient Safety Indicator (HAC/PSI) and Quality Indicators capture as appropriate through documentation validation.
• Verifies assignment of DRGs, MCC/CCs, Hospital Acquired Conditions (HACs) and Patient Safety Indicators (PSIs) that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department policies and procedures.
• Selects the optimal principal diagnoses with appropriate POA indicator assignment and sequencing of risk adjustment diagnoses following established guidelines.
• Reviews work queues to identify charts that need to be coded and prioritizes as per department-specific guidelines and within designated timelines.
• Follows up on On-hold accounts daily for final coding.
• Identifies and requests physician queries following established guidelines when existing documentation is unclear or ambiguous following American Health Information Management (AHIMA) guidelines and established organization policies.
• Ensures all open queries initiated by Clinical Documentation Specialists have been addressed prior to final coding.
• Adheres to department standards for productivity and accuracy.
• Identifies and trends coding issues escalating identified concerns.
• Consults, provides professional expertise to and collaborates with clinical documentation specialists on coding and documentation practices and standards.

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